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Anselm G. Junemann, Rudolf Kunze, Nikolaos Bellios, Gerd Wallukat, Friedrich E. Kruse, Martin Herrmann, Juergen Rech; Stimulatory Autoantibodies against β2-adrenergic Receptors in Open-angle Glaucoma - Effect of Immunoadsorption on Antibody Level and Intraocular Pressure. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2428.
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Stimulatory autoantibodies (AABs) against ß2 adrenergic receptors were detected in roughly 75% of patients with primary open-angle glaucoma (POAG) and ocular hypertension (OHT) by a bioassay (IOVS 2006; 47: ARVO E-Abstract 3384). To study a possible role of these AABs in the regulation of intraocular pressure (IOP) immunoadsorption (IA) was performed in POAG.
Five patients (age 52 to 71 years, two female, three male) with POAG (glaucoma history in mean 13.6 years, mean IOP 23.9±4.4mmHg, in mean 3 medications) were included in this study. Extracorporal plasma separation was performed by centrifugation technique (Cobe Spectra®) while the running parameters such as column volume, loading volume, desorption and regeneration volume, speed of processing and numbers of cycles were fixed and controlled by the Adasorb® device (medicap, Ulrichstein). One treatment cycle consist of treatment on five consecutive days of IA by using two reusable adsorbers (Globaffin®, Fresenius Medical Care Affina GmbH). Levels of AABs, immunoglobulines, and IOP were examined before IA and 1 week, 2 weeks, 4 weeks, 2, 4, 6, and 12 months after IA, respectively.
In all patients antibodies were washed out totally by IA. AABs remained undetectable during the follow-up in three patients, in the other two patients AAB levels were detected 4 months after IA. The reduction of the levels of total IgG and IgG3 was in mean 91% and 72%, respectively. Four weeks after IA total IgG and IgG3 reached normal values. In all patients IOP reduction was observed. This effect on IOP remained from several days during IA to the end of follow-up. Recurrence of AAB went in parallel with the increase of IOP after IA. The amount of IOP reduction ranged from 10% to 40%. In addition, the range of IOP fluctuation (30mmHg to 5.6 mmHg) and the number of medications (3.0 to 1.5) were reduced.
The results of this pilot study may indicate a possible role of AABs in the aequous humor dynamics and IOP regulation and may support autoimmune aspects of the pathogenesis of OAG. These findings support the need for future trials to further assess the therapeutic potential of immunoadsorption in glaucoma patients.
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